30例非感染性后巩膜炎临床特征分析

Non-Infectious Posterior Scleritis:Clinical Analysis in a Series of 30 Patients

目的:总结非感染性后巩膜炎的临床特征,以期为临床上准确诊断、合理治疗提供依据。方法:回顾性系列病例研究。收集2007年1月至2016年10月在中山大学中山眼科中心和温州医科大学附属第二医院就诊,经各项检查确诊为非感染性后巩膜炎的患者30例(40眼),年龄(35.2±14.3)岁。所有病例都进行既往史回顾和病史分析,收集入选病例相关临床资料,包括最佳矫正视力(BCVA)、眼压、眼部常规检查和辅助检查等,并进行临床分析。结果:10例双眼发病,33眼(83%)以眼痛伴视力下降为主诉就诊。就诊时10眼(25%)视力下降到0.1以下,13眼(32%)视力在0.1~0.6之间,17眼(43%)视力在0.6~1.2之间。眼压为(13.2±4.4)mmHg。在眼前段,22眼(55%)伴发前段巩膜炎,18眼(45%)有前葡萄膜炎症状;在眼后段,22眼(55%)发生视盘水肿,21眼(53%)存在视网膜静脉扩张,13眼(33%)黄斑部隆起脱离。另外发现渗出性视网膜脱离7眼(18%),黄斑部星芒样渗出3眼(8%),脉络膜脱离3眼(8%),视网膜/脉络膜皱褶2眼(5%),视网膜中央静脉阻塞3眼(8%)。所有患者眼部B超检查发现球壁弥漫性增厚,眼球壁后可见环形低回声,共同形成典型的“T”形征,球壁厚度为(2.21±0.85)mm。结论:非感染性后巩膜炎临床表现多样,眼底可以有视盘水肿、静脉扩张、黄斑部渗出、黄斑部脱离隆起等体征,B超检查是后巩膜炎最特异性检查方法,可用于明确诊断。

Objective:Summarize the clinical features in posterior scleritis,to provide the basis for correct diagnosis and rational treatment in clinic.Methods:Retrospective interventional case series study.This study included 30 patients(40 eyes),average±standard deviation age 35.2±14.3 years,who were diagnosed from January 2007 to October 2016 at the Second Affiliated Hospital of Wenzhou Medical University and Zhongshan Ophthalmic Center of Sun Yat-sen University with non-infectious posterior scleritis.The medical history of all cases was documented,and the clinical features were recorded.The examinations included best corrected visual acuity,slit lamp examination,intraocular pressure,B-scan ultrasonography,and other routine eye and auxiliary examinations.Results:Posterior scleritis was unilateral in 20 cases and bilateral in 10 cases at presentation.Thirty-three eyes(83%)were painful and accompanied by vision loss.The visual acuity of 10 eyes(25%)was below 0.1,13 eyes(32%)were between 0.1 and 0.6,and 17 eyes(43%)were between 0.6 and 1.2.The mean intraocular pressure was 13.2±4.4 mmHg.Eighteen eyes(45%)had anterior uveitis,and 22 eyes(55%)had anterior scleritis.In the posterior segment,22 eyes(55%)had optic disc swelling,21 eyes(53%)had retinal phlebectasia,and 13 eyes(33%)had macular exudation detachment.Seven eyes(18%)had exudative retinal detachment,3 eyes(8%)had macular stellate exudation,3 eyes(8%)had choroidal detachment,3 eyes(8%)had central retinal vein occlusion,and 2 eyes(5%)had a retinal or choroidal striae.B-scan ultrasound found increased thickness of the eyeball,with an average of 2.21±0.85 mm.The posterior chamber had an annular hypoechoic with a typical T-sign.Conclusions:Non-infectious posterior scleritis exhibited some features in common with concurrent of anterior uveitis,disc swelling,retinal phlebectasia,macular exudation detachment,and retinal striae.B-scan ultrasound was the most useful diagnostic resource to confirm non-infectious posterior scleritis,with cases having the typical T-sign.